https://leader.pubs.asha.org/article.aspx?articleid=1921108When a Child Goes SilentA bilingual child stops speaking and nobody knows why. With no language to guide them, speech-language pathologists may struggle to determine whether the root cause is selective mutism, the silent period of second-language learning, or something else.2014-11-01T00:00:00FeaturesKatherine Preston

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Features | November 01, 2014

When a Child Goes SilentA bilingual child stops speaking and nobody knows why. With no language to guide them, speech-language pathologists may struggle to determine whether the root cause is selective mutism, the silent period of second-language learning, or something else.

When a Child Goes SilentA bilingual child stops speaking and nobody knows why. With no language to guide them, speech-language pathologists may struggle to determine whether the root cause is selective mutism, the silent period of second-language learning, or something else.

When a Child Goes SilentA bilingual child stops speaking and nobody knows why. With no language to guide them, speech-language pathologists may struggle to determine whether the root cause is selective mutism, the silent period of second-language learning, or something else.

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When most kindergarten children have a problem they raise their hand to tell the teacher. Not this Vietnamese boy. Hit one day with a nosebleed, he uttered not a word. Instead, he sat stock-still until his teacher finally noticed the blood trickling down his face.

This scene was typical for this child, who spent his days in silence, only whispering single words if prompted. In fact, by the time his teacher referred him to speech-language pathologist Vicky Valyear for an evaluation, he had been silent at school for more than six months.

Troubled by the boy’s lack of speech, Valyear realized, “We would never know if he was in any pain.”

Her first step in evaluating him was arranging for a Vietnamese translator to help her learn more from the boy’s parents. Over a series of phone conversations, Valyear found out that he spoke at home, but not in full sentences. She also learned that he got upset when his three older siblings tried to make him talk. Although Vietnamese was his first language, he had spent the previous year in an English-speaking preschool and appeared to understand English directions.

Describing the situation as “the most challenging case I’ve ever had,” Valyear was cautious about jumping to conclusions. She enlisted the help of other professionals to find out if this was a “silent period” of language development, selective mutism or something else entirely.

Language gone underground

One in five school-age children now speaks a language other than English at home (according to the National Center for Educational Statistics), and acquiring a second language is a complex process involving intricate cognitive and social strategies.

For most, this process includes a time when their “linguistic development goes underground,” according to Muriel Saville-Troike in an article published in the Journal of Child Language back in 1988—an indication of how long researchers have recognized the phenomenon of the “silent period.”

This distinctive period in young bilingual learners’ lives typically starts when they realize that their home language is not understood at school and that their second-language skills are not yet sufficient to make themselves understood. Reacting to this new situation, they may stop speaking as they focus on listening to the sounds of this new language. It is a time for observing those around them, digesting what they hear, and building understanding of the new vocabulary and syntax.

The silent period can be as short as one month or it can stretch to more than six months, but gradually the child will move beyond silence. During this normal process, children first start to repeat words, copying those around them. Next they quietly start to practice new words and phrases and, finally, they “go public” with their new second language.

Valyear’s student seemed to have become “stuck” in the first stages of language acquisition. Although he appeared to understand English directions and happily interacted with other children in a nonverbal way, he remained silent or uttered single words quietly.

Because there didn’t seem to be a specific lack of language comprehension or ability, Valyear thought that there might be more to it than a typical silent period. She reached out to the ASHA community and the school’s psychologist to determine if the child was possibly experiencing selective mutism.

Selective silence

Unlike the time of negotiation and learning that characterizes a typical second-language learner’s silent period, selective mutism is a condition that can be caused, at least in part, by severe social anxiety.

Selective mutism is characterized by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, as the failure of a child to speak in at least one setting, while speaking normally in others. This condition significantly interferes with educational, occupational or communicative functioning and lasts for at least one month. To complicate matters, one of the exclusionary criteria is a limited proficiency in the acquired language.

And even though still a relatively rare condition—affecting seven in every 1,000 children (according to a 2002 study in the Journal of the American Academy of Child and Adolescent Psychiatry)—the prevalence of selective mutism is higher than originally thought.

More important, according to a 2005 study by Claudio O. Toppelberg of Children’s Hospital in Boston, also published in the Journal of the American Academy of Child and Adolescent Psychiatry, about a third of children affected by selective mutism are raised in multilingual settings.

“Children immersed in a new language environment are at a greater risk for selective mutism for a number of reasons,” says SLP and selective mutism expert Suzanne Hungerford.

“First, they may have increased anxiety due to being in a foreign social and linguistic environment,” says Hungerford, a professor at SUNY Plattsburgh. “They sometimes become socially isolated at school when they don’t speak the language of their peers. Also, children who are naturally shy, anxious or inhibited may ‘get stuck’ in the silent period of second-language learning, as the silence becomes habitual and extended, and anxiety about speaking prevents them from moving to a stage of language expression.”

A clinician, if unaware of the complexity of learning a second language and expecting near instant fluency, could erroneously diagnose selective mutism in a child who remains mute for just one month. The identification process is by no means straightforward, and it can be difficult to differentiate selective mutism from silent periods in children learning a second language. To help clinicians make the correct diagnosis, Toppelberg suggests selective mutism can be suspected when a child exhibits all of the following:

Remains silent even after a protracted period of second-language exposure.

Is silent at school in his or her native language as well as in the language of the school.

Appears shy, overly anxious or inhibited.

Although the silent period of language learning is normal and often uneventful, teachers, parents and SLPs should be alert to any child who is overly anxious or socially isolated while going through the process of learning a new language.

Pulling out the bad feelings

When SLP Ellen Hemrick met 4-year-old Elena, the child had been selectively mute for six months. Elena had grown up speaking Spanish and attended a predominantly Spanish-speaking daycare. Now she had suddenly become mute in her new school with her English-speaking teacher. She had stopped speaking in either language at school, in public settings and with people outside of her family.

Elena had a few friends whom she could whisper to in certain situations, but she was not able to express her basic needs to her teacher. Hemrick was very concerned when the child wet her pants when her teacher “forced” her to ask to go to the bathroom out loud in class.

To rule out the possibility of an extended silent period, Hemrick started by assessing Elena’s receptive language skills. Both her English and Spanish seemed to be above normal for her age, and she was perfectly proficient in English and precocious in Spanish. “With the absence of a language disorder, it was important to treat the anxiety,” Hemrick says

And so began their sessions together. They started by drawing pictures and playing games. The games slowly became more demanding of speech, yet Hemrick never asked Elena to speak and showed no reaction as she began to whisper, whisper fluently in English, and gradually whisper while making eye contact. They worked together on breathing and muscle relaxation exercises. Finally, Hemrick introduced the idea of “blowing away bad feelings.”

“We visualized pulling the bad feelings out of our chests and blowing them out of our mouths,” Hemrick says. “I asked her mother to practice this at home and to blow away tangible things such as paper or cotton balls. We even ripped up a drawing of ‘bad feelings’ and blew it off our palms.”

A week later, Elena started talking out loud to Hemrick, and Elena’s mother reported that Elena was talking in other situations, too. She went as far as wanting to apologize to the people she hadn’t spoken to, and Hemrick explained that she didn’t have to feel bad about the past, that it was time to move on. They made a plan for her to speak on the first day of school. Months later, she has no symptoms of selective mutism at school.

Luckily for Elena, Hemrick understood Hungerford’s point that “preventive intervention should be a priority, since cases of severe or long-standing selective mutism are often difficult to remediate.”

This early intervention, so key for young children at risk, is often complicated by the mistaken belief that the child will just “grow out of it” and sometimes by the parents’ own misplaced guilt. Although Hemrick felt capable of helping Elena, many professionals are wary of treating a condition with which they’re unfamiliar.

And there remains little research on preventing selective mutism in second-language learners. However, Elena’s experience shows how transformative certain treatments can be. Hungerford suggests a number of ways SLPs can help children at risk to interact socially and reduce communication anxiety, without forcing them to speak:

Find a “speech buddy” who speaks the same native language as the child and with whom the child can communicate at school.

Create a low-demand language environment and simplify speech directed to the child.

Allow verbal responses to questions in the child’s native language.

Foster a warm, nurturing and supportive environment for the child.

Allow the child to work one-on-one or in small groups to decrease communication anxiety.

Create early, meaningful opportunities for simple language expression. For example, teach just one or two key words or phrases that the child can use early in the language-learning process, and reward the child when they are used in a communicative context. The word “more,” for example, can be used extensively during snack time to get more food or drink.

Do not require or demand that the child speak, but demonstrate the potency of expressive language through example.

Continue to build the child’s receptive language to foster greater confidence in the use of the new language.

The root cause

Much like Elena, Valyear’s student had certain symptoms that seemed to lead to a diagnosis of selective mutism: He was silent across both languages, his silence was prolonged, and he seemed to display a high level of speaking anxiety. And yet, Valyear was cautious. Having spoken to all of the adults in the boy’s life, she believed that there could be a physical reason that he was unwilling, or unable, to talk. Some of his teachers had told her about some very unusual symptoms that didn’t correlate with either a silent period or selective mutism: He constantly cleared his throat in class and had unpleasant breath.

After multiple phone calls with his parents, Valyear discovered that he had been evaluated by a child study team at age 3 to explore the need for educational or speech support, but the parents had not followed up on the evaluation and there had been no examination of his vocal mechanism. Suspecting that there might be another reason behind his silence, she scheduled him for an ear, nose and throat assessment.

After a series of tests, the child was diagnosed with postglottal edema (swelling caused by fluid accumulation in the soft tissues of the larynx) with reflux laryngitis (irritation in the back of the throat from acid coming up from the stomach).

This case highlights the varied reasons that a child may be unable or unwilling to speak, from a silent period misconstrued as selective mutism to medical issues. Occasionally a child may even stop talking because of trauma. And yet, for a diagnosis of selective mutism to be made, the child must speak in some situations and not others. Alternative causes of mutism must be ruled out before a diagnosis of selective mutism is made.

Today, Valyear is eager to follow up with her client to see whether his silence has resolved or has become habitual. This case shows the importance of bridging the gap between the child’s home and school. As Valyear puts it, “It took everybody to come together and talk about what was going on.”

3 Comments

November 5, 2014

Allison Hanschen

Treating Anxiety

This is a wonderful article with a good success story of Elena and properly done techniques! I would be wary, however, in my setting that treating anxiety is outside my professional scope of practice. We should definitely approach each situation individually and with personal competence in mind.

November 9, 2014

Jessica Carter

Treating Anxiety

Wonderful article. I do have a concern about the role of SLPs "treating anxiety," as one of the SLPs in the article mentioned. We can certainly help create a supportive environment to foster communication, but is it within our scope of practice to "treat" anxiety?

November 12, 2014

Rhonda Friedlander

Treating non-verbal children

I too, have had similar experiences working with Native American Children. Most are first generation English Speakers, but have "social anxiety" in larger group settings. I think it is imperative that we, as professionals, help them ease out of the silence. Perhaps we should team up with others who have the expertise in treating this type of disorder.